Albany Ketamine Medical Infusions PLLC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

ALBANY KETAMINE MEDICAL INFUSIONS PLLC

Practice address

523 Western Ave
Albany, NY 12203-1617

Phone

(518) 249-5700

NPI assigned

Jul 19, 2021

Last updated

Dec 11, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Philip Hansen, MDNPI 1083876957

Title

Medical Director

Phone

(518) 249-5700

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Philip Hansen, M.D.

  • Anesthesiology Physician
  • Albany, NY
  • NPI 1083876957
  Medicare reassignment NPD Authorized official
• Cary Erin Fosback, LMHC

  • Mental Health Counselor
  • Albany, NY
  • NPI 1376213645
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702252800000",
    "number": "1861065856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 WEMBLEY CT",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122053851",
            "telephone_number": "518-249-5700",
            "fax_number": "518-942-2248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 WESTERN AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122031617",
            "telephone_number": "518-249-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBANY KETAMINE MEDICAL INFUSIONS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-19",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "518-249-5700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Albany Family Medicine PLLC (Jose M David The Practice of Family Medcine)
• Albany Gastroenterology Consultants PLLC
• Albany Gastroenterology Consultants, P.C.
• Albany Gynecology & Fertility
• Albany Ivf-Fertility and Gynecology Center
• Albany Liver and Pancreas Surgery PC
• Albany Med Health System (Albany Medical Center Pharmacy)
• Albany Medical Center
• Albany Medical Center Hospital
• Albany Medical Center Hospital (AMCH Dept of Radiology)

• Infusion Therapy Clinic/Center in Albany, NY
• Providers in Albany, NY by specialty
• Infusion Therapy Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.